Introduction: Detethering of the spinal cord has historically been the treatment of choice for TCS in the setting of spinal dysraphisms. Recurrent TCS occurs 5-80% of patients. Risk of neurological injury, CSF leak, and wound breakdown increase with subsequent procedures. Kokubun et al. described using PVCSO without microsurgical detethering to relieve stretch strain on the spinal cord; however, there is a paucity of literature on its success. Here we describe our experience with PVCSO for TCS.
Methods: A prospectively collected database patients with TCS who underwent PVCSO or were being monitored for potential surgery was analyzed. A team of two neurosurgeons evaluated each patient for potential benefit from spinal shortening osteotomies. Preoperative evaluation included MRI and upright radiographs to assess for location and type of tethering and presence of deformity. Single stage posterior PVCSO were conducted at a neutral level rostral to the tethering site, shortening by 10-15mm. When present PVCSOs were concurrently utilized to correct deformities.
Results: 6 patients were assessed. 4 patients had failed previous microsurgical detethering at least once. 4 patients underwent PVCSO due to worsening of symptoms: 2 with history of myelomeningocele repair and 2 with arachnoid adhesions after spinal subdural hematoma. All 4 had resolution of weakness, numbness, and radicular pain of legs. Incontinence improved in the patient with arachnoid adhesions. There was no worsening of neurological function. 1 patient with spinal cord herniation and scoliosis, had improved radiculopathy from detethering.
Conclusions: In this series all patients who underwent PVCSO for TCS experiences improvement in motor, sensory, and pain symptoms. Indirect relief of in-line strain and stretch on the spinal cord is possible through PVCSO by shortening the spinal column, without high risk of recurrence of symptoms or neurological injury as there is no direct manipulation of neural elements. PVCSO can be utilized for both congenital and acquired TCS.
Patient Care: Patients with recurrent tethered cord (congenital or acquired) may be offered a procedure with potentially lower risk of neurologic injury to improve their symptoms.
Learning Objectives: 1)Understand the application of spinal shortening osteotomies in the treatment of tethered cord syndrome. 2) Be able to provide propper preoperative evaluation of tethered cord patients. 3) Recognize the key factors in planning spinal column shortening osteotomies.